Preventive services in a health maintenance organization: how well do pediatricians screen and educate adolescent patients?

OBJECTIVE: To determine whether pediatricians in managed care settings adhere to national guidelines concerning the provision of clinical preventive services. DESIGN: Surveys were mailed between September 1996 and April 1997 to all pediatricians practicing in a California group-model health maintenance organization. The survey asked pediatricians about their screening and education practices on 34 recommended services and the actions taken with adolescent patients who have engaged in risk behavior. RESULTS: The response rate was 66.2% (N = 366). Pediatricians, on average, screened 92% of their adolescent patients for immunization status and blood pressure; 85% for school performance; 60% to 80% for obesity, sexual intercourse, cigarette use, alcohol use, drug use, and seat belt and helmet use; 30% to 47% for access to handguns, suicide, eating disorders, depression, and driving after drinking alcohol; fewer than 20% for use of smokeless tobacco, sexual orientation, sexual and physical abuse, and riding a bike or swimming after drinking alcohol; and 26% to 41% for close friends' engagement in risk behavior. Pediatricians' assessment and education with adolescent patients who screened positive for risk behavior was particularly low. Female physicians, physicians who saw a greater proportion of older adolescents, and recent medical school graduates were more likely to provide preventive services. CONCLUSIONS: Pediatricians in this health maintenance organization provide preventive services to adolescent patients at rates below recommendations but at rates greater than physicians in other practice settings. Improvement is especially needed in the areas that contribute most to adolescent mortality and for patients who screen positive for a risk behavior.     

Respiratory viral infections in children with asthma: do they matter and can we prevent them?

ABSTRACT: BACKGROUND: Asthma is a major public health problem with a huge social and economic burden affecting 300 million people worldwide. Viral respiratory infections are the major cause of acute asthma exacerbations and may contribute to asthma inception in high risk young children with susceptible genetic background. Acute exacerbations are associated with decreased lung growth or accelerated loss of lung function and, as such, add substantially to both the cost and morbidity associated with asthma. DISCUSSION: While the importance of preventing viral infection is well established, preventive strategies have not been well explored. Good personal hygiene, hand-washing and avoidance of cigarette smoke are likely to reduce respiratory viral infections. Eating a healthy balanced diet, active probiotic supplements and bacterial-derived products, such as OM-85, may reduce recurrent infections in susceptible children. There are no practical anti-viral therapies currently available that are suitable for widespread use.     

The patellofemoral joint: do age and gender affect skeletal maturation of the osseous morphology in children?

Background

The osseous morphology of the patellofemoral joint is an independent factor that affects the biomechanics of patellofemoral instability.

Objective

The purpose of this study is to determine age- and gender-related differences in the osseous morphology of the patellofemoral joint in children during skeletal maturation.

Materials and methods

This study was approved by the institutional review board and was HIPAA-compliant. We included 97 children and young adults (age range 5–22 years; 51 girls and 46 boys, mean ages 14.3 years and 13.7 years, respectively). We studied 1.5-T knee MR exams, measuring the osseous morphology of the patellofemoral joint (lateral trochlear inclination, trochlear facet asymmetry, trochlear depth, patellar height ratio, tibial tubercle-trochlear groove distance, and lateral patellofemoral angle) for each MR exam. We compared measurements to published values for patellofemoral instability. Physeal patency (open or closing/closed) was determined on MR. We assessed the associations between MR osseous measurements and gender, age and physeal patency using Wilcoxon rank sum test and least square means regression models.

Results

The osseous patellofemoral joint morphology measurements were all within a normal range. There were no significant correlations between MR osseous measurements and age, gender or physeal patency.

Conclusion

During skeletal maturation, age and gender do not affect the osseous morphology or congruency of the patellofemoral joint.     

The relationship between interview characteristics and accuracy of recall in young children: do individual differences matter?

The relationship between interview characteristics and accuracy of recall in young children, as mediated by child characteristics, was examined. The interview characteristics included preinterview instructions and level of questioning. Fifty-six children ranging from ages 3 to 6 years participated in a Circus Day event and were interviewed 10 days later. Following either instructions or filler questions, children were questioned about the event. Results indicated that based on several individual difference factors, young children varied significantly in the accuracy of their interviews and their ability to resist misleading questions. However, individual differences did not mediate children's ability to benefit from different question types or preinterview instructions. As a whole, children provided limited information to the most open-ended questions and more correct information to highly structured questions. In contrast to the research with older children, younger children did not benefit from preinterview instructions. Suggestions for future research and implications for investigative interviews in the field of child abuse are discussed.     

Comparison of ureteroscopic procedures with rigid and semirigid ureteroscopes in pediatric population: does the caliber of instrument matter?

Objectives  

To compare the results of two different ureteroscopes in pediatric ureteroscopy (URS) procedures.     

Low and high birth weight as risk factors for obesity among 4 to 5-year-old Australian children: does gender matter?

Studies testing whether birth weight and childhood obesity differ by gender are lacking. We aimed to describe the relationship between birth weight and childhood overweight/obesity and investigate the influence that gender has on this relationship among 4 to 5-year-old children. We performed a secondary analysis of an Australian nationally representative cross-sectional study in 4 to 5-year-old children. The main outcome measure was child overweight and obesity. We found that low birth weight (LBW) was associated with lower risk of overweight/obesity among girls at 4–5 years before (OR 0.50, 95%CI 0.32, 0.77) and after adjusting for socio-demographic factors (OR 0.51 95% CI 0.33, 0.80) and ethnicity (OR 0.52, 95%CI 0.33, 0.81) but was not associated with child overweight/obesity among boys before or after adjustment. High birth weight (HBW) was associated with a higher risk of overweight/obesity among both girls (adjusted OR: 1.76, 95%CI 1.12, 2.78) and boys (adjusted OR: 2.42 95% CI 2.06, 2.86). Conclusion: There are gender differences in the association of birth weight with child overweight/obesity. HBW was associated with a higher risk of child overweight/obesity in boys and girls before and after adjustment for socio-demographic factors. However, LBW was associated with a lower risk of child overweight/obesity in girls but not in boys. These gender differences need to be considered when planning interventions to reduce child overweight/obesity.     

Nonparental care and infant health: do number of hours and number of concurrent arrangements matter?

Objectives

Previous research found that centre-based childcare is related to more illnesses early in life. The goal of this longitudinal study is to determine whether infant health in the first year of life is also related to the amount of time spent in non-parental care and the number of concurrent non-parental care arrangements.

Methods

Information on infant health and non-parental care was obtained through monthly maternal interviews across the first year of life. The occurences of respiratory, digestive, general, and skin illnesses and complaints were used as dependent variables, while the number of hours and the number of arrangements per week were used as predictors. Analyses were done separately in infants for whom centre-based childcare is included in their arrangements (n = 107), and for those which it is not (n = 61).

Results

Infants spending more hours in non-parental care had more respiratory and general illnesses. Infants who were cared for in more concurrent arrangements had fewer respiratory and general, but more skin illnesses. These results only applied to infants that included centre-based childcare in their arrangements. In the group of infants that did not attend centre-based childcare, health was not related to either the number of hours or the number of arrangements.

Conclusions

Number of hours and number of arrangements do matter in relation to infant health early in life, but only for infants who attend centre-based childcare. While more hours were related to more illnesses, more arrangements were related to both fewer and more illnesses, depending on the type of illnesses.     

Pitfalls in the diagnosis of hemophilia severity: What to do?

Measurements of factor VIII coagulation activity (FVIII:C) may vary and result in misclassification of hemophilia A with delay in initiation of prophylactic treatment. We describe two young brothers who were diagnosed as moderate hemophilia patients and therefore not prophylactically treated with factor VIII concentrate despite frequent bleeding events. These findings emphasize the importance of (i) multiple measurements of FVIII:C by certified laboratories, (ii) adjustment of treatment when test results do not correspond to clinical symptoms, (iii) relevance of additional DNA mutation analysis in patients with hemophilia A, and (iv) treatment in centers with expertise.     

A multilevel analysis of the relation of socioeconomic status to adolescent depressive symptoms: does school context matter?

OBJECTIVE: To determine whether the socioeconomic context of the school environment is associated with adolescent depressive symptoms independent of individual household income.Study design Data were drawn from a 1995 nationally representative study of 7th to 12th grade students. Multivariable linear regression at the school and individual levels assessed the relation between income and depressive symptoms. Multilevel modeling techniques were then used to understand how these factors are jointly associated with adolescent depressive symptoms. PARTICIPANTS: Adolescents (n=13,235) in grades 7 through 12 from 132 schools whose parent provided income information. RESULTS: Linear regression analyses indicated that lower household income, average school income, and increasing school-level income inequality were significantly (P<.001) associated with depressive symptoms. Further examination of these relations through multilevel modeling indicated that both household income (P<.01) and average school income (P<.05) were significantly related to depressive symptoms after adjusting for covariates, with evidence for an interaction between the two. The impact of lower household income on depressive symptoms was approximately 2-fold greater for students attending a poor versus a rich school. CONCLUSIONS: School context is associated with adolescents' depressive symptoms, even after adjusting for individual-level factors. The school environment may partially buffer the adverse influence of lower household income on adolescent depressive symptoms.     

Crohn’s disease,autoimmune thyroiditis,and beta-thalassemia trait in an adolescent: an unusual combination of diseases

An adolescent with complaints of fatigue, tachycardia, abdominal discomfort, and blood-stained diarrhea is presented. Clinical and laboratory evaluation revealed a microcytemic anemia with iron deficiency, beta thalassemia, and thyrotoxicosis with thyroid antibodies. Crohn’s disease was confirmed on endoscopy. A rapid normalization of clinical and laboratory parameters was observed following the initiation of therapy and further exacerbation of her illness was prevented. Although the simultaneous occurrence of Crohn’s disease, autoimmune thyroiditis, and a beta-thalassemia trait is likely to be coincidental, the combination of an autoimmune thyroid disease and Crohn’s disease is rare in pediatrics. Several issues of importance in the treatment of these conditions are discussed. Rectal blood loss associated with Crohn’s disease may lead to severe iron deficiency, especially in patients with preexistent beta-thalassemia trait, and those with thyroiditis are prone to developing hypothyroidism following treatment, requiring that they be monitored closely.